Impact of Beta Blockers on Long-Term Mortality in Takotsubo Syndrome: A Real-World Analysis of the TriNetX Global Collaborative Network Database

Abstract Aims There are limited clinical data for beta blockers in Takotsubo syndrome (TTS). This real-world analysis aims to evaluate the impact of beta-blockers on all-cause mortality in TTS. Methods and Results This retrospective analysis was conducted using the Global Collaborative Network of the TriNetX database. Patients with TTS were identified between 01/01/2005 and 06/06/2025 and stratified based on post-diagnosis beta-blocker use. Propensity-score matching using the greedy nearest-neighbor matching was utilized to balance the cohorts. Outcomes of interest was in-hospital mortality at 1-, 3-, and 5-years. During the study period, 54,855 patients with TTS were identified (beta-blocker group 39,108, control: 15,747). The beta blocker group was on average older (71 vs 69.7 years), of white race (74.2% vs 68.9%), and had higher rates of comorbidities. Following matching, both cohorts had 14,268 patients each with a mean age of 70 years and well balanced in demographics, comorbidities, medications, and laboratory data. Matched cohort analysis demonstrated beta blocker use was associated with lower all-cause mortality at 1-year (risk ratio [RR]: 0.67; 95% confidence interval [CI]: 0.63-0.71], 3 years (RR: 0.78; 95% CI: 0.74-0.82), and 5 years (RR: 0.81; 95% CI: 0.76-0.84). Conclusions Beta blocker use in patients with TTS was associated with a lower risk of short- and long-term mortality up to 5 years.